An Explanation of Lumbar Laminectomy Surgery

The proprietor of East Portland Orthopedic and Fracture Clinic, Timothy Treible, MD has expertise in spine and back procedures. As a board-certified orthopedic surgeon, Dr. Timothy Treible has performed many back surgeries, including lumbar microlaminectomies.

Lumbar microlaminectomies are intended to treat lumbar disc protrusions and some cases of foraminal stenosis, a condition in which nerves in the lower back become compressed. More extensive laminotomies are performed in cases of spinal stenosis. Symptoms of spinal stenosis include pain and oftentimes the sensation of weakness, tingling, and numbness in the lower back, buttocks, and legs.

The operation consists of the removal of bone from above and below the affected nerve root. The resulting decompression creates more space around the root, allowing for healing. To reach the nerve, the surgeon makes a 1/2 to 1 inch incision and retracts the left and right back muscles from the vertebrae. The doctor then removes a portion of the lamina, a small bone that shields the spinal cord and nerve roots. The facets that overlie the nerve root can then be delicately resected using micro instruments carefully preserving the facet structure to prevent instability.

Artificial Disc Replacement – Promising New Treatment for Back Pain

Timothy Treible, MD, is a board-certified orthopedic surgeon. For the better part of three decades, he has served patients in the Portland, Oregon, area. Dr. Timothy Treible practiced at the East Portland Orthopedic and Fracture Clinic and performed a wide range of spinal procedures, including artificial disc replacement.

Patients who suffer from severe low back, or lumbar, pain, whose conditions are not resolved by noninvasive procedures over a period of six months or more, may be candidates for spinal surgery. Artificial disc replacement (ADR) refers to procedures for replacing the discs between spinal vertebrae. The discs act as cushions or spacers between the bones and keep them from rubbing together or pinching spinal nerves. First available to patients in 2004, this approach is gaining popularity as a way to reduce chronic back pain by replacing damaged discs.

Artificial disc replacement provides some advantages over spinal fusions, another surgical approach commonly used in cases of severe low back pain. It allows for a speedier return to normal mobility following surgery, and it generally facilitates a more mobile spine. This is because spinal fusions are literally hard connections of adjacent spinal bones, which reduces movement. Although ADR is much newer than fusions and bears more clinical study, it is worth exploring for those considering surgical remedies for their back pain.

An Overview of the Chief Resident Position

Timothy Treible, MD, completed the Medical College of Wisconsin Orthopedic Residency program after graduating from the institution with his medical degree. During his orthopedic residency, Dr. Timothy Treible was named chief resident. He practiced at East Portland Orthopedic and Fracture Clinic, diagnosing and treating complex orthopedic issues.

The responsibilities of a chief resident at a hospital or medical facility can vary significantly depending on the nature of the resident’s post. The chief resident in a pediatric program, for example, will be tasked with several jobs relating directly to child and infant health care, whereas the chief resident of a chemical dependency program will not often interact with such young patients.

A chief resident at any facility, however, is charged with the overall well being of all patients under his or her supervision. The chief resident role is one of both medical and administrative leadership, extending from the oversight of day-to-day clinic operations to operating room decisions.

Making rounds is one of the most common parts of a chief resident’s job. During morning rounds, chief residents assist other residents and personnel teams in organizing their patient schedules and workloads for the day while evening rounds are often utilized as teaching opportunities.

Sacroiliac Joint Fusion Shows Promise in Pain Relief

Dr. Timothy Treible is board certified in orthopedic surgery. He has seen patients at the East Portland Orthopedic and Fracture Clinic and the Legacy Mount Hood Medical Center. Dr. Timothy Treible has been interested in helping patients with particularly challenging conditions; one procedure he performed is sacroiliac (SI) joint fusion.

The SI joint is where the lumbar, or lower, spine meets the pelvis. It is particularly vulnerable to painful dysfunction, being the point where the upper body’s weight load is delivered to the lower body. Although SI joint pain can often be resolved with noninvasive therapy, there are certain patients whose symptoms do not abate. In many cases, SI joint fusion provides relief. Fusion surgery, or arthrodesis, literally fuses two bones together, forming a single bone. By taking movement away from the joint, pain is reduced.

Current approaches to SI joint fusion are minimally invasive. A recent study, performed by the National Institutes of Health, reports positive outcomes in terms of pain relief and 100 percent satisfaction among patients. The study, which examined the outcomes of 40 patients, reported no adverse effects from the procedure.

Reverse Total Shoulder Replacement (Part 2) – Timothy J. Treible, M.D.

Reverse total shoulder arthroplasty accomplishes many goals that have never been achieved before in shoulder surgery for rotator cuff arthropathy. Rather than replacing the ball and socket the way they are naturally in the body, the reverse is performed in which the ball portion is switched over to a socket and the socket portion is switched over to a ball. Doing this allows a new joint to be formed, which is now metal on polyethylene rather than bone on bone. Additionally, the muscles that are preserved are able to substitute for the loss of the rotator cuff muscles and allow the patient to flex and abduct their shoulder using their deltoid muscle instead of their rotator cuff.

This type of replacement is an evolving technology and, as with any new technology, I am sure that future changes in prosthesis design and mechanics will improve outcomes. At this point in time the reverse total shoulder seems to be the best surgical treatment for individuals with irreparable rotator cuff tears and severe associated arthritis.

More information on Timothy Treible, MD and the services he offers at East Portland Orthopedic and Fracture Clinic can be found at http://www.orthopdx.com.

Timothy J. Treible, M.D. on Reverse Total Shoulder Replacement (Part 1)

The treatment of patients suffering from chronic shoulder pain and disability as a consequence of rotator cuff tears has evolved dramatically. Prior to the introduction of reverse total shoulder replacements, treatment of patients with rotator cuff tears and subsequent severe arthritis caused by the abnormal mechanics of the shoulder resulting in so-called cuff arthropathy has been fraught with difficulty. Now, a type of shoulder replacement called a reverse total shoulder is available to treat these very challenging problems.

Patients oftentimes present with longstanding shoulder pain which has been treated with a number of nonoperative modalities including analgesics, physical therapy, and observation for years prior to being evaluated by an orthopedic surgeon. Unfortunately, rotator cuff tears are a very common shoulder problem and without early intervention, rotator cuff tears spontaneously progress and lead to a condition known as cuff arthropathy, in which the articular cartilage of the shoulder is lost, leaving the patient with a painful and very weak shoulder. Oftentimes, this progresses to the point where the patient is unable to lift their arm. They may not even be able to reach to touch the top of their head, and in some situations are unable to use that hand even to feed themselves.

The deterioration that occurs inside a shoulder as a consequence of a neglected rotator cuff tear is a complicated cascade. Since two of the tendons of the rotator cuff, the supraspinatus and infraspinatus, are important in initiating shoulder motion in a flexion and abduction type of arc, if those two tendons no longer are functioning other muscles attempt to compensate.

Unfortunately, when some of these other muscles, specifically the deltoid, take over the function of the rotator cuff with shoulder abduction and flexion, this may result in the humeral head subluxing out of the socket superiorly. This can cause the top of the humerus to scrape on the undersurface of the shoulder blade resulting in the development of arthritis.

Once the cartilage has been lost from the ball portion of the shoulder (the humeral head) there are no good techniques available that can regrow that lost cartilage. Making things worse, when the rotator cuff tendons initially tear if they are not promptly repaired oftentimes the tendons simply absorb, retract, and scar into position and become irreparably misshapen and shortened and can no longer be reconstructed appropriately.

More information on Timothy Treible, MD and the services he offers at East Portland Orthopedic and Fracture Clinic can be found at www.orthopdx.com.